Abstract
BACKGROUND: Bacillus Calmette-Guérin (BCG)-related complications, non-tuberculous mycobacteria (NTM) and classical tuberculosis (TB) are all examples of mycobacterial diseases. Accurate pathogen identification and host immunological state are essential for diagnosis and treatment. CASE PRESENTATION: A four-month-old male child with disseminated BCG (Bacillus Calmette-Guérin) infection and TB as a result of STAT1 deficiency (Mendelian susceptibility to mycobacterial diseases MSMD) and a 17-year-old girl with a chronic cutaneous and soft tissue Mycobacterium abscessus infection are the two different examples that we describe. Granulomatous inflammation and acid-fast bacilli (AFB) were present in both individuals. The infant was awaiting hematopoietic stem cell transplantation after receiving extended antimycobacterial therapy but did not survive. Following the failure of initial empirical antitubercular treatment (ATT), the adolescent needed NTM-targeted combination therapy with clarithromycin, amikacin, and ethambutol. CONCLUSION: The need of careful clinical evaluation and ongoing diagnostic vigilance is underscored by the highlighted diagnostic problems. These instances show how unusual mycobacterial illness presentations might cause delays in diagnosis, especially in susceptible groups. Accurate diagnosis depends on confidence in complete diagnostic methods, which include thorough clinical examination, suitable imaging, microbiological testing and immunological assessment. This case series emphasizes how important it is to combine interdisciplinary skills in order to handle complex diagnoses, identify uncommon mycobacterial infections in a timely manner and direct efficient treatment plans, all of which improve patient outcomes.